Fillable Commonwealth of Massachusetts Public Safety Exam Eligibility Form

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Commonwealth of Massachusetts Public Safety Exam Eligibility Form

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The Commonwealth of Massachusetts Public Safety Exam Eligibility Form form is 1 page long and contains:

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U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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PUBLIC SAFETY ELIGIBILITY FORM
EXAM TITLE: ___________________________________________ EXAM DATE: ______________________________________
MUNICIPALITY:_________________________________________ DEPARTMENT: ___________________________________
APPLICANT'S NAME
(Please list in alphabetical order)
Last 4 digits of
SOCIAL SECURITY #
PERMANENT TITLE ON
EXAM DATE
DATE OF ENTRY TO
PERMANENT TITLE
**
DATE FIRST CERTIFIED
TO PERMANENT TITLE
(PERM OR TEMP)
** Only complete this column if Date of Entry to Permanent Title is less than one year prior to Exam Date; if this column is to be completed,
provide the date that the applicant’s name first appeared on a certification for Permanent or Temporary promotion/appointment in his/her
Permanent Title, regardless of whether that certification resulted in the applicant’s promotion/appointment to such title.
I HEREBY DECLARE THAT THE INFORMATION INCLUDED ON THIS FORM IS TRUE AND CORRECT AND MADE UNDER THE
PENALTIES OF PERJURY.
SIGNATURE: __________________________________________________ TITLE: ___________________________ DATE: ________
*Completed form must be attached to the Neogov requisition for this examination title. Revised 03/14/16
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Commonwealth of Massachusetts Public Safety Exam Eligibility Form

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Completed 16 May 2020

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